Healthcare Provider Details

I. General information

NPI: 1205046620
Provider Name (Legal Business Name): LAWRENCE ANDREW SHIRLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 NICHOLASVILLE RD STE 202
LEXINGTON KY
40503-1472
US

IV. Provider business mailing address

1760 NICHOLASVILLE RD STE 202
LEXINGTON KY
40503-1472
US

V. Phone/Fax

Practice location:
  • Phone: 859-277-5711
  • Fax: 859-967-1770
Mailing address:
  • Phone: 859-277-5711
  • Fax: 859-967-1770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number53721
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number53721
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: